Browse > Article
http://dx.doi.org/10.5125/jkaoms.2016.42.5.259

Post-traumatic and postoperative neurosensory deficits of the inferior alveolar nerve in mandibular fracture: a prospective study  

Yadav, Sunil (Department of Dental Surgery, BPS Government Medical College for Women)
Mittal, Hitesh Chander (Department of Dental Surgery, BPS Government Medical College for Women)
Malik, Sunita (Department of Dental Surgery, BPS Government Medical College for Women)
Dhupar, Vikas (Department of Maxillofacial Surgery, Goa Dental College)
Sachdeva, Akash (Department of Maxillofacial Surgery, Inderprastha Dental College & Hospital)
Malhotra, Vijaylaxmy (Department of Dental Surgery, SHK Government Medical College)
Singh, Gurdarshan (Department of Dental Surgery, BPS Government Medical College for Women)
Publication Information
Journal of the Korean Association of Oral and Maxillofacial Surgeons / v.42, no.5, 2016 , pp. 259-264 More about this Journal
Abstract
Objectives: We evaluated and recorded post-traumatic and postoperative neurosensory deficits of the inferior alveolar nerve (IAN) in mandibular fracture in order to identify associated risk factors. Materials and Methods: This was a prospective cohort study composed of 60 patients treated for mandibular fracture. The primary study variable was the change between the post-traumatic IAN neurosensory examination score and the score after fracture reduction. Risk factors were categorized as demographic, anatomic, fracture displacement, and treatment. Appropriate descriptive and bivariate statistics were computed. Results: Sixty patients with unilateral mandibular fracture reported within 24 hours of injury were evaluated over a one-year period. A post-traumatic neurosensory deficit was observed in 52 patients (86.7%), the percentage of which was reduced to 23.3% over the follow-up period. Abnormal postoperative neurosensory scores were significantly higher in angle fracture cases (33.3%) compared to body fracture cases (11.1%). When recovered and non-recovered neurosensory scores were compared by fracture location, 88.9% of body fracture cases showed significant recovery compared to 66.7% of mandibular angle fracture cases. Cases with less than 5 mm fracture displacement showed statistically significantly higher neurosensory recovery scores (90.6%) compared to those with more than 5 mm fracture displacement (60.7%). Conclusion: Use of a miniplate with mono-cortical screws does not play a role in increasing IAN post-traumatic neurosensory deficit. Early management can reduce the chances of permanent neurosensory deficit. Mandibular fracture displacement of 5 mm or more and fracture location were found to be associated with an increased risk of post-traumatic IAN neurosensory score worsening.
Keywords
Mandibular nerve; Nerve injury; Mandibular fractures;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Schultze-Mosgau S, Erbe M, Rudolph D, Ott R, Neukam FW. Prospective study on post-traumatic and postoperative sensory disturbances of the inferior alveolar nerve and infraorbital nerve in mandibular and midfacial fractures. J Craniomaxillofac Surg 1999;27:86-93.   DOI
2 Stacey DH, Doyle JF, Mount DL, Snyder MC, Gutowski KA. Management of mandible fractures. Plast Reconstr Surg 2006;117:48e-60e.   DOI
3 Theriot BA, Van Sickels JE, Triplett RG, Nishioka GJ. Intraosseous wire fixation versus rigid osseous fixation of mandibular fractures: a preliminary report. J Oral Maxillofac Surg 1987;45:577-82.   DOI
4 Cabrini Gabrielli MA, Real Gabrielli MF, Marcantonio E, Hochuli-Vieira E. Fixation of mandibular fractures with 2.0-mm miniplates: review of 191 cases. J Oral Maxillofac Surg 2003;61:430-6.   DOI
5 Andreasen JO, Storgard Jensen S, Kofod T, Schwartz O, Hillerup S. Open or closed repositioning of mandibular fractures: is there a difference in healing outcome? A systematic review. Dent Traumatol 2008;24:17-21.   DOI
6 Bede SY, Ismael WK, Al-Assaf DA, Omer SS. Inferior alveolar nerve injuries associated with mandibular fractures. J Craniofac Surg 2012;23:1776-8.   DOI
7 Halpern LR, Kaban LB, Dodson TB. Perioperative neurosensory changes associated with treatment of mandibular fractures. J Oral Maxillofac Surg 2004;62:576-81.   DOI
8 Iizuka T, Lindqvist C. Sensory disturbances associated with rigid internal fixation of mandibular fractures. J Oral Maxillofac Surg 1991;49:1264-8.   DOI
9 Campbell RL, Shamaskin RG, Harkins SW. Assessment of recovery from injury to inferior alveolar and mental nerves. Oral Surg Oral Med Oral Pathol 1987;64:519-26.   DOI
10 Dodson TB, Perrott DH, Kaban LB, Gordon NC. Fixation of mandibular fractures: a comparative analysis of rigid internal fixation and standard fixation techniques. J Oral Maxillofac Surg 1990;48:362-6.   DOI
11 Akal UK, Sayan NB, Aydogan S, Yaman Z. Evaluation of the neurosensory deficiencies of oral and maxillofacial region following surgery. Int J Oral Maxillofac Surg 2000;29:331-6.   DOI
12 Marchena JM, Padwa BL, Kaban LB. Sensory abnormalities associated with mandibular fractures: incidence and natural history. J Oral Maxillofac Surg 1998;56:822-5; discussion 825-6.   DOI
13 Bochlogyros PN. A retrospective study of 1,521 mandibular fractures. J Oral Maxillofac Surg 1985;43:597-9.   DOI
14 Thurmuller P, Dodson TB, Kaban LB. Nerve injuries associated with facial trauma: natural history, management, and outcomes of repair. Oral Maxillofac Surg Clin North Am 2001;13:283-94.
15 Iizuka T, Lindqvist C. Rigid internal fixation of mandibular fractures. An analysis of 270 fractures treated using the AO/ASIF method. Int J Oral Maxillofac Surg 1992;21:65-9.   DOI
16 Iizuka T, Lindqvist C. Rigid internal fixation of fractures in the angular region of the mandible: an analysis of factors contributing to different complications. Plast Reconstr Surg 1993;91:265-71;discussion 272-3.   DOI
17 Chuong R, Donoff RB, Guralnick WC. A retrospective analysis of 327 mandibular fractures. J Oral Maxillofac Surg 1983;41:305-9.   DOI
18 Zuniga JR, Essick GK. A contemporary approach to the clinical evaluation of trigeminal nerve injuries. Oral Maxillofac Surg Clin North Am 1992;4:353-67.
19 Zuniga JR, Meyer RA, Gregg JM, Miloro M, Davis LF. The accuracy of clinical neurosensory testing for nerve injury diagnosis. J Oral Maxillofac Surg 1998;56:2-8.   DOI
20 Dodson TB, Kaban LB. Recommendations for management of trigeminal nerve defects based on a critical appraisal of the literature. J Oral Maxillofac Surg 1997;55:1380-6.   DOI
21 Ardary WC. Prospective clinical evaluation of the use of compression plates and screws in the management of mandible fractures. J Oral Maxillofac Surg 1989;47:1150-3.   DOI
22 Melmed EP, Koonin AJ. Fractures of the mandible. A review of 909 cases. Plast Reconstr Surg 1975;56:323-7.   DOI
23 Tu HK, Tenhulzen D. Compression osteosynthesis of mandibular fractures: a retrospective study. J Oral Maxillofac Surg 1985;43:585-9.   DOI
24 Niederdellmann H, Shetty V. Solitary lag screw osteosynthesis in the treatment of fractures of the angle of the mandible: a retrospective study. Plast Reconstr Surg 1987;80:68-74.   DOI
25 Luhr HG, Reidick T, Merten HA. Results of treatment of fractures of the atrophic edentulous mandible by compression plating: a retrospective evaluation of 84 consecutive cases. J Oral Maxillofac Surg 1996;54:250-4; discussion 254-5.   DOI
26 Kearns GJ, Perrott DH, Kaban LB. Rigid fixation of mandibular fractures: does operator experience reduce complications? J Oral Maxillofac Surg 1994;52:226-31.   DOI
27 Queral-Godoy E, Valmaseda-Castellon E, Berini-Aytes L, Gay-Escoda C. Incidence and evolution of inferior alveolar nerve lesions following lower third molar extraction. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;99:259-64.   DOI
28 Kuriakose MA, Fardy M, Sirikumara M, Patton DW, Sugar AW. A comparative review of 266 mandibular fractures with internal fixation using rigid (AO/ASIF) plates or mini-plates. Br J Oral Maxillofac Surg 1996;34:315-21.   DOI